Clinical Medicine Journal
Articles Information
Clinical Medicine Journal, Vol.1, No.4, Oct. 2015, Pub. Date: Sep. 26, 2015
The Significance of Absence of Coronary Calcification by Multidetector Row Computed Tomography (MDCT) in Patients Suspected of Coronary Artery Atherosclerosis
Pages: 145-151 Views: 973 Downloads: 479
Authors
[01] Nasir A. Muhammad, School of Medicine, Faculty of Medical Science, University of Sulaimanyah, Iraqi Kurdistan, Iraq.
Abstract
Background: Coronary artery disease continues to be one of the leading causes of morbidity and mortality, a reliable and reproducible non-invasive diagnostic test for the detection and grading of coronary artery stenosis is multidetector row computed tomography (MDCT) coronary angiography. The presence of coronary artery calcium (CAC) is almost 100% sensitive for the presence of atherosclerotic coronary plaque and increasing calcium scores are associated with an increasing likelihood of both obstructive disease and severity of coronary artery disease (CAD). Objective: To see the significance of absence of calcification in the coronary arteries and it’s correlation with the degree and the frequency of coronary atherosclerosis. Patients and methods: This prospective study was carried out at CT-angiography department in Slemani cardiac specialty hospital, Kurdistan region/Iraq from Nov. 13th 2013 to Aug. 8th 2014 in total 118 sequential patients (Their age range was between 40-78 years, with an average age of 53 years. 79 cases were female and 39 cases were male) were underwent computed tomography coronary angiography scanning (CTCA). Results: According to the Statistical Package for the Social Sciences 21 (SPSS) Regarding the calcification and its relation to the atheroma: (among the 118 cases with zero calcification, only 4 cases showed presence of atheroma (3.39%) and among them only in one case the atheroma was significant, which means less than one percent (0.85%) of the cases showed significant stenosis that needed intervention). Conclusion: Absence of CAC is highly sensitive for exclusion of coronary artery atherosclerosis, but it does not totally exclude it and most of the degree of the stenosis (if present) is non-significant.
Keywords
Coronary Artery Disease, Coronary CT Angiography, Coronary Calcium Index
References
[01] Rosamond W, Flegal K, Furie K, et al. Heart disease and stroke statistics--2008 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. Jan 29 2008; 117(4): e25-146.
[02] National Service Framework for Coronary Heart Disease. www.doh.gov.uk/nsf/coronary.htm.
[03] McCollough CH, Zink FE. Performance evaluation of a multislice CT system. Med Phys 1999; 26: 2223—30.
[04] Klingenbeck-Regn K, Schaller S, Flohr T, Ohnesorge B, Kopp AF, Baum U. Sub-second multi-slice CT: Basics and applications. Eur J Radiol 1999; 31: 110—24.
[05] Becker CR, Ohnesorge BM, Schoepf UJ, Reiser MF. Current developments of cardiac imaging with multi-detector row CT. Eur J Radiol 2000; 36: 97—103.
[06] N.E. Manghata,*, G.J. Morgan-Hughesb, A.J. Marshallb, C.A. Roobottoma Departments of aClinical Radiology, and bCardiology, Derriford Hospital, Plymouth, UK Received 2 December 2004; received in revised form 7 April 2005; accepted 4 May 2005.
[07] Sevrukov A, Jelnin V, Kondos GT. Electron beam CT of the coronary arteries: cross-sectional anatomy for calcium scoring. AJR Am J Roentgenol 2001; 177: 1437-1445.
[08] Baim DS, Grossman W. Coronary angiography. Cardiac catheterization, angiography, and intervention. 5th ed. Baltimore, Md: Williams & Wilkins, 1996; 183-208.
[09] Vogl TJ, Abolmaali ND, Diebold T, et al. Techniques for the detection of coronary atherosclerosis: multi-detector row CT coronary angiography. Radiology 2002; 223: 212-220.
[10] Scanlon PJ, Faxon DP, Audet AM, et al. ACC/AHA guidelines for coronary angiography: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (Committee on Coronary Angiography). J Am Coll Cardiol 1999; 33: 1756-1824.
[11] Gonda J. de Jonge, Peter M. A. van Ooijen, Jean-Louis Sablayrolles.
[12] Guido Ligabue, and Felix Zijlstra, et al. Coronary radiology, 2nd revised edition, 2009.
[13] Schweiger MJ. Coronary arteriography. In: Uretsky BF, eds. Cardiac catheterization: concepts, techniques and applications. Malden, Mass: Blackwell Science, 1997; 196-260.
[14] Maryam Ghadimi Mahani, Coronary Artery Anomalies on CT Angiography Appl Radiol.2011; 40(6): 18-25.
[15] Von Ludinghausen M.; The clinical anatomy of coronary arteries. Adv Anat Embryol Cell Biol. 167 2003 III–VIII, 1–111.
[16] Angelini P., Tivellato M., Donis J.; Myocardial bridges: a review. Prog Cardiovasc Dis. 26 1983: 75-88.
[17] Bourassa M.G., Butnaru A., Lesperance J., Tardif J.C.; Symptomatic myocardial bridges: overview of ischemic mechanisms and current diagnostic and treatment strategies. J Am Coll Cardiol. 41 2003:351-359.
[18] Möhlenkamp S., Hort W., Ge J., Erbel R.; Update on myocardial bridging. Circulation. 106 2002:2616-2622.
[19] Alegria J.R., Herrmann J., Holmes D.R. Jr., Lerman A., Rihal C.S.; Myocardial bridging. Eur Heart J. 26 2005: 1159-1168.
[20] Goitein O., Lacomis J.M.; Myocardial bridging: noninvasive diagnosis with multidetector CT. J Comput Assist Tomogr. 29 2005: 238-240.
[21] Czekajska-Chehab T.A., Madejczyk A., Wojcik M., Drop A.; The concomitant intramyocardial bridging in the left coronary artery and anomalous origin of the right coronary artery—evaluation in the ECG gated multi-slice computed tomography (MSCT). Ann Univ Mariae Curie Sklodowska (Med). 59 2004: 361-367.
[22] Manghat N.E., Roobottom C.A., Marshall A.J.; Images in cardiology. Intramyocardial bridging of the left anterior descending artery: appearance of arterial compression on ECG gated multidetector row CT. Heart. 92 2006: 262
[23] Malik IS. Inflammation in cardiovascular disease. J R Coll Physicians Lond 2000;34:205—7.
[24] Stary HC, Chandler AB, Dinsmore RE, Fuster V, Glagov S,Insull Jr W, et al. A definition of advanced types of atherosclerotic lesions and a histological classification of atherosclerosis. Circulation 1995 92: 1355—74.
[25] Schroeder S, Kopp AF, Baumbach A, et al. Non-invasive detection and evaluation of atherosclerotic plaques with multislice CT. J Am Coll Cardiol 2001; 37: 1430—5.
[26] Stary HC, Chandler AB, Dinsmore RE, Fuster V, Glagov S, Insull W Jr, et al. A definition of advanced types of atherosclerotic lesions and a histological classification of atherosclerosis. A report from the Committee on Vascular Lesions of the Council on Arteriosclerosis, American Heart Association. Circulation. Sep 1 1995; 92(5): 1355-74. [Medline].
[27] Eugene C Lin, MD Attending Radiologist, Teaching Coordinator for Cardiac Imaging, Radiology Residency Program, Virginia Mason Medical Center; Clinical Assistant Professor of Radiology, University of Washington School of Medicine.
[28] O'Rourke RA, Brundage BH, Froelicher VF. American College of Cardiology/American Heart Association Expert Consensus document on electron-beam computed tomography for the diagnosis and prognosis of coronary artery disease. Circulation. Jul 4 2000; 102(1): 126-40.
[29] J Bayne Selby Jr, MD Professor of Radiology, Co-Director, Division of Interventional Radiology, Department of Radiology, Medical University of South Carolina coronary artery calcification on CT scanning May 16 2013.
[30] Flohr T, Schoepf U, Kuettner A, et al. Advances in cardiac imaging with 16-section CT systems. Acad Radiol 2003; 10: 386—401.
[31] Hastreiter D, Lewis D, Dubinsky TJ. Acute myocardial infarction demonstrated by multidetector CT scanning. Emerg Radiol 2004; 11: 104—6.
[32] Achenbach S, Ropers D, Pohle K, et al. Influence of lipidlowering therapy on the progression of coronary artery calcification: A prospective evaluation. Circulation 2002; 106: 1077—82.
[33] Callister TQ, Raggi P, Cooil B, Lippolis NJ, Russo DJ. Effect of HMG-Co A reductase inhibitors on coronary artery disease as assessed by electron-beam tomography. N Engl J Med 1998; 339: 1972—8.
[34] Ulzheimer S, Kalender W. Assessment of calcium scoring performance in cardiac CT. Eur Radiol 2003; 13: 484—97.
[35] Ohneserge B, Flohr T, Becker C, et al. Cardiac imaging by means of ECG gated multisection spiral CT: Initial experience. Radiology 2000; 217: 564—71.
[36] Becker CR, Kleffel T, Crispin A, et al. Coronary artery calcium measurement: Agreement of multirow detector and electron beam CT. AJR Am J Roentgenol 2001; 176: 1295—8.
[37] Martuscelli E, Romagnoli A, D’Eliseo A, et al. Accuracy of thin-slice computed tomography in the detection of coronary stenoses. Eur Heart J 2004; 12: 1043—8.
[38] MESA (Multi-Ethnic Study of Atherosclerosis). http://www.mesa-nhlbi.org/Participants.aspx (December 2004).
[39] Coronary Artery Risk Development in Young Adults (CARDIA) Study. http://www.cardia.dopm.uab.edu/ (December 2004).
[40] Haberl R, Becker A, Leber A et al (2001) Correlation of coronary calcification and angiographically documented stenoses in patients with suspected coronary artery disease: results of 1, 764 patients. J Am Coll Cardiol 37: 451–457.
[41] Budoff MJ, Diamond GA, Raggi P, et al (2002) Continuous probabilistic prediction of angiographically significant coronary artery disease using electron beam tomography. Circulation 105: 1791–1796.
[42] Georgiou D, Budoff MJ, Kaufer E, Kennedy JM, Lu B, Brundage BH (2001) Screening patients with chest pain in the emergency department using electron beam tomography: a follow-up study. J Am Coll Cardiol 38: 105–110.
[43] A. S. Agatston, W. R. Janowitz, F. J. Hildner, N. R. Zusmer, M. Viamonte, and R. Detrano, “Quantification of coronary artery calcium using ultrafast computed tomography,” Journal of the American College of Cardiology, vol. 15, no. 4, pp. 827–832, 1990.
[44] Rumberger JA, Brundage BH, Rader DJ. Electron beam computed tomographic coronary calcium scanning: a review and guidelines for use in asymptomatic persons. Mayo Clin Proc. Mar 1999; 74(3): 243-52.
[45] Rumberger JA. Coronary artery calcification: ""...empty your cup."" Am Heart J. May 1999; 137(5): 774-6.
[46] Shaw LJ, Raggi P, Schisterman E, Berman DS, Callister TQ (2003) Prognostic value of cardiac risk factors and coronary artery calcium screening for all-cause mortality. Radiology 228: 826–833.
[47] Abbott RD, Ueshima H, Masaki KH et al (2007) Coronary artery calcification and total mortality in elderly men. J Am Geriatr Soc 55: 1948–1954.
[48] Vliegenthart R, Oudkerk M, Hofman A et al (2005) Coronary calcification improves cardiovascular risk prediction in the elderly. Circulation 112: 572–577.
[49] Matthijs Oudkerk, Arthur E. Stillman, 2 Sandra S. Halliburton, 3 Willi A. Kalender, 4 Stefan Möhlenkamp, 5 Cynthia H. McCollough, 6 Rozemarijn Vliegenthart, 1 Leslee J. Shaw, 2 William Stanford, 7 Allen J. Taylor, 8 Peter M. A. van Ooijen, 1 Lewis Wexler, 9 and Paolo Raggi2 coronary artery calcium screening: current status and recommendations from the europian society of cardiac radiology and north American society for cardiovascular imaging .Published online May 27, 2008. doi: 10.1007/s10554-008-9319-z.
[50] Raggi P, Shaw LJ, Berman DS, Callister TQ (2004) Gender-based differences in the prognostic value of coronary calcification. J Womens Health (Larchmt) 13: 273–283.
[51] MacMahon S, Peto R, Cutler J, Collins R, Sorlie P, Neaton J. Blood pressure, stroke and coronary heart disease, part 1: prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias. Lancet. 1990; 335: 765-774.
[52] Epstein SE, Quyyumi AA, Bonow RO. Sounding board: sudden cardiac death without warning: possible mechanisms and implications for screening asymptomatic population. N Engl J Med. 1989; 321: 320-324.
[53] Kuller LH. AHA Symposium/epidemiology meeting: atherosclerosis. Discussion: why measure atherosclerosis? Circulation. 1993; 87(suppl II): II-34-II-37.
[54] Detrano RC. Why the controversy about electron beam computed tomographic screening for coronary atherosclerosis? Br Heart J. 1994; 72: 313-314.
[55] Doyle AE. Does hypertension predispose to coronary disease? In: Laragh JH, Brenner BM, eds. Hypertension: Pathophysiology, Diagnosis and Management. New York, NY: Raven Press Publishers; 1990: 119-125.
[56] Doherty TM, Detrano RC. Coronary arterial calcification as an active process: a new prospective on an old problem. Calcif Tissue Int. 1994; 54: 224-230.
[57] Fitzpatrick LA, Severson A, Edwards WD, Ingram RT. Diffuse calcification in human coronary arteries: association of osteopontin with atherosclerosis. J Clin Invest. 1994; 94: 1597-1604.
[58] Shanahan CM, Cary NR, Metcalfe JC, Weissberg PL. High expression of genes for calcification-regulating proteins in human atherosclerotic plaques. J Clin Invest. 1994; 92: 2392-2402.
[59] Wong ND, Sciammarella MG, Polk D et al (2003) The metabolic syndrome, diabetes, and subclinical atherosclerosis assessed by coronary calcium. J Am Coll Cardiol 41: 1547–1553.
[60] Schurgin S, Rich S, Mazzone T (2001) Increased prevalence of significant coronary artery calcification in patients with diabetes. Diabetes Care 24: 335–338.
[61] Khaleeli E, Peters SR, Bobrowsky K, Oudiz RJ, Ko JY, Budoff MJ (2001) Diabetes and the associated incidence of subclinical atherosclerosis and coronary artery disease: implications for management. Am Heart J 141: 637–644.
[62] Mielke CH, Shields JP, Broemeling LD (2001) Coronary artery calcium, coronary artery disease, and diabetes. Diabetes Res Clin Pract 53: 55–61.
[63] Hoff JA, Quinn L, Sevrukov A et al (2003) The prevalence of coronary artery calcium among diabetic individuals without known coronary artery disease. J Am Coll Cardiol 41: 1008–1012.
[64] Wong ND, Rozanski A, Gransar H et al (2005) Metabolic syndrome and diabetes are associated with an increased likelihood of inducible myocardial ischemia among patients with subclinical atherosclerosis. Diabetes Care 28: 1445–1450.
[65] AP Burke, A Farb, GT Malcolm, Y-H Liang, J Smialek, R Virmani Coronary risk factors and plaque morphology in men with coronary disease who died suddenly N Engl J Med, 336 (1997), pp. 1276–1282.
[66] CL Grines, EJ Topol, WW O’Neill, et al. Effect of cigarette smoking on outcome after thrombolytic therapy for myocardial infarction Circulation, 91 (1995), pp. 298–303.
[67] Allison MA, Wright CM: A comparison of HDL and LDL cholesterol for prevalent coronary calcification. Int J Cardiol 95: 55 –60, 2004.
[68] Snell-Bergeon JK, Hokanson JE, Jensen L, MacKenzie T, Kinney G, Dabelea D, Eckel RH, Ehrlich J, Garg S, Rewers M: Progression of coronary artery calcification in type 1 diabetes: The importance of glycemic control. Diabetes Care. 26: 2923 –2928, 2003.
[69] Stary HC: The sequence of cell and matrix changes in atherosclerotic lesions of coronary arteries in the first forty years of life. Eur Heart J 11 [Suppl E]: 3 –19, 1990.
[70] Bostrom K, Watson KE, Horn S, Wortham C, Herman IM, Demer LL: Bone morphogenetic protein expression in human atherosclerotic lesions. J Clin Invest 91: 1800 –1809, 1993.
[71] Nallamothu BK, Saint S, Bielak LF, Sonnad SS, Peyser PA, Rubenfire M, Fendrick AM: Electron-beam computed tomography in the diagnosis of coronary artery disease: A meta-analysis. Arch Intern Med 161: 833 –838, 2001.
[72] O’Rourke RA, Brundage BH, Froelicher VF, Greenland P, Grundy SM, Hachamovitch R, Pohost GM, Shaw LJ, Weintraub WS, Winters WL Jr, Forrester JS, Douglas PS, Faxon DP, Fisher JD, Gregoratos G, Hochman JS, Hutter AM Jr, Kaul S, Wolk MJ: American College of Cardiology/American Heart Association Expert Consensus document on electron-beam computed tomography for the diagnosis and prognosis of coronary artery disease. Circulation 102: 126 –140, 2000.
[73] Greenland P, LaBree L, Azen SP, Doherty TM, Detrano RC: Coronary artery calcium score combined with Framingham score for risk prediction in asymptomatic individuals. JAMA 291: 210 –215, 2004; erratum in JAMA 291: 563, 2004.
[74] Dr. Peter A. McCullough, Division of Nutrition and Preventive Medicine, William Beaumont Hospital, 4949 Coolidge, Royal Oak, Effect of Lipid Modification on Progression of Coronary Calcification doi: 10.1681/ASN.2005060664 JASN November 1, 2005 vol. 16.
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